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Fam Pract Manag. 2001;8(6):14

To the Editor:

I understand your indignation about public advertisement of electron beam tomography [Editor’s Page, March 2001, page 10]. But where is your indignation for the administrative/fiscal equivalent of “dumbing down” when Medicare reimbursement is not only considered the gold standard and the index for other payers, but its rules also dictate how a physician should practice?

Consider the following answer to a coding and documentation question in the March 2001 issue that asked which prolonged services code should be used: “99354. This is determined by subtracting the time that CPT indicates is typically associated with the level of office visit you provided from the time you actually spent in face-to-face contact with the patient. The CPT manual says a 99213 typically involves 15 minutes of face-to-face time. Subtracting 15 from 70 leaves 55 minutes. Prolonged services code 99354 accounts for the first hour of direct patient contact ‘beyond the usual service,’ according to CPT. It may be used to report prolonged service of 30 minutes to one hour and should be submitted with the office visit code. If the prolonged service exceeded one hour, you could also submit 99355.”

Say what? Is this what we studied medicine to be doing? Is this how we must spend our time? All this effort so Medicare can reimburse – when it does – a mere pittance for our efforts, send our patients to “spy” on us as part of Medicare’s anti-fraud campaign and over-regulate us with mind-numbing schemes as the answer above attests to?

Save the angst for the right party! I wish the profession could develop whatever it takes to challenge Medicare reimbursement and rules.


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